About Gallbladder / Gall Stones

The gallbladder is a small pear-shaped organ located beneath the liver on the right side of the abdomen. It stores bile, a digestive fluid released into the small intestine. Bile helps eliminate waste from the liver, including bilirubin formed during red blood cell breakdown. An imbalance in these waste components can result in the formation of gallstones. These stones can range from the size of a sand grain to that of a golf ball.

Also known as gallstones, these are solid fragments that develop in the gallbladder, a tiny organ found below the liver. They may trigger inflammation called cholecystitis if left untreated. The gallbladder's job is to store bile produced by the liver, which carries waste such as cholesterol and bilirubin. When these substances are imbalanced, stones can form, ranging in size from tiny specks to large lumps.

Types of Gallbladder / Gall Stones

Gallstones fall into two main categories:

Pigment Stones: These are dark brown or black stones made mostly from bilirubin. They are more common in those with liver issues, sickle cell anemia, or certain blood disorders.

Cholesterol Stones: These yellow-green stones consist largely of cholesterol and sometimes contain bile salts or bilirubin. They represent around 80% of all gallstones and are the most common type.

Gallbladder / Gall Stones : Signs and Symptoms

Gallbladder stone pain may occur anytime but often follows fatty meals like fried food. It typically affects the upper right abdomen or the center of the belly.

If the stones remain undetected, symptoms may include:

• Fever
• Jaundice (yellow skin and eyes)
• Sore throat
• Skin irritation or itching
• Loose stools
• Mental confusion
• Chills
• Reduced appetite
• Accelerated heartbeat
• Stomach bloating

Gallbladder / Gall Stones : Causes

Chemical imbalances in bile can lead to gallstone formation:

• Excess Cholesterol: Too much cholesterol that bile can’t dissolve forms into crystals and eventually stones.
• Increased Bilirubin: Conditions like liver disease or infections increase bilirubin, resulting in pigment stones.
• Gallbladder Stasis: Poor emptying of the gallbladder causes bile to become highly concentrated, encouraging stone growth.

Gallbladder / Gall Stones : Risk Factors

Demographic:

• Women are more prone—especially during pregnancy or when using birth control or hormone replacement.
• Risk rises significantly after age 40.
• Native and Mexican Americans are at higher risk genetically.

Medical Conditions:

• Obesity or rapid weight reduction (through diet or surgery).
• Disorders like diabetes or high triglycerides increase stone formation.
• Liver or gut diseases such as cirrhosis or Crohn’s disease.

Lifestyle Choices:

• Diets rich in fat and low in fiber.
• Prolonged fasting may reduce gallbladder function.

Gallbladder / Gall Stones : Complications

• Biliary Colic: Sharp pain due to a blocked bile duct.
• Cholecystitis: Infection or inflammation of the gallbladder with fever and pain.
• Pancreatitis: A gallstone may block the pancreatic duct, leading to serious inflammation.
• Cholangitis: Bile duct infection that can result in jaundice or sepsis.
• Gallbladder Cancer (rare): Long-standing inflammation may elevate cancer risk.

Gallbladder / Gall Stones : Diagnosis

Medical History & Physical Evaluation

• The doctor will assess for signs like pain, nausea, fever, or jaundice.
• Palpation might show tenderness in the upper right abdomen.

Abdominal Ultrasound

• The preferred imaging test, capable of detecting stones and inflammation.
• It's non-invasive and reliable.

Blood Work

• Helps spot infection, duct obstruction, or inflammation:
  
  • Elevated white cell count (infection)
  • Liver enzymes (ALT, AST, ALP, bilirubin)
  • Amylase/lipase (pancreatic function)

CT Scan

• Useful for emergencies, especially to identify pancreatitis or ruptures.
• Less sensitive than ultrasound for stones.

HIDA Scan

• This scan uses a radioactive tracer to study gallbladder function and detect cholecystitis or duct blockages.

MRI / MRCP

• Offers a clear picture of the gallbladder, liver, and bile ducts.
• Especially helpful for identifying stuck stones.

Endoscopic Ultrasound (EUS)

• Combines scope and ultrasound to get accurate views of gallbladder and bile ducts.

ERCP

• Used mainly for treatment, this method helps remove bile duct stones and evaluate blockages.

Gallbladder / Gall Stones : Treatment Management

Cholecystectomy: The standard approach for treating symptomatic gallstones is surgical gallbladder removal.

• Advanced Laparoscopic Cholecystectomy: This minimally invasive surgery uses small incisions and specialized instruments guided by a camera. It offers faster recovery, reduced pain, and minimal scarring.
• ERCP: A diagnostic and therapeutic tool for managing bile duct stones and related complications.
• Open Cholecystectomy: In complex or advanced cases, open surgery might be needed, though it’s rarely performed now due to advancements in laparoscopy.